Tag: fraud

A patient recruiter was found guilty of one count of conspiracy to pay and receive health care kickbacks and three counts of receipt of health care kickbacks, according to the U.S. Department of Justice (DOJ). Between 2009 and 2017, Dominic Trumbo, 45, of Lexington, Ky., owner of Trumbo Consulting Agency, participated in an illegal kickback […]

In a July report, the Department of Health and Human Services Office of Inspector General (OIG) revisited its top 25 unimplemented recommendations for reducing fraud, waste and abuse. Several of the recommendations involve home health, hospice or personal care services. The OIG recommends the implementation of a statutory mandate requiring surety bonds for home health […]

A former Mississippi hospice owner Charline Brandon has pleaded guilty to making fraudulent hospice claims. Brandon acknowledged submitting nearly $12 million in fraudulent claims to Medicare and nearly $3 million to Medicaid while she was running Haven Hospice, North Haven Hospice, Lion Hospice and North Lion Hospice. A 2017 indictment alleged she was engaged in […]

From Home Health Line. The HHS Office of Inspector General (OIG) has announced the formation of a 10th area where regional Medicare Fraud Strike Force Teams will operate: New Jersey/Philadelphia. The team will focus on health care fraud and illegal opioid prescriptions, according to the U.S. Department of Justice. “The devastation the opioid epidemic is […]

Post Acute Medical, LLC, (PAM) a Pennsylvania-based operator of long-term care and rehab nationwide, has agreed to pay the United States, Texas, and Louisianaafter violating the False Claims Act. PAM’s conduct allegedly resulted in false claims to Medicare as well as certain Medicaid programs. The latter are jointly funded by both the federal and state […]

On January 23, the U.S. Department of Veterans Affairs (VA) and HHS announced a partnership to share data, data analytics tools, and best practices for identifying and preventing fraud, waste and abuse. This newest partnership enhances ongoing efforts between the country’s two largest public-private health-care payment organizations to help America’s veterans by leveraging the gains […]

After three years of operations, the Centers for Medicare & Medicaid Services (CMS) reported that the agency’s advanced analytics system, called the Fraud Prevention System, identified or prevented $820 million in inappropriate payments in the program’s first three years. The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for […]

Yes another SNF, another therapy contract and more fraud settlements. The only thing that isn’t different is the contractor – RehabCare once again (a coincidence?…not likely). In news released late last week, a Maine SNF settled with the Department of Justice for $1.2 million, allegations of improper Medicare billings for “unnecessary, inflated, and unreasonable” therapy […]

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Are you prepared to prevent financial burden under PDGM? To ensure success, agencies must take actionable steps now to fully understand exactly how the new Patient-Driven Groupings Model will impact coding scenarios and how these updates will affect revenue cycle.

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What will your revenue and expenses look like for a Medicare Part A resident admitted under PDPM? Find out with this free questionnaire from The Association for Medicare Billing and Reimbursement (AMBR) for Long-Term Care.

The way agencies get paid and aspects of almost all areas of business will completely shift under the new Patient-Driven Groupings Model (PDGM). We’ve partnered with industry experts and rounded up crucial action-items you won’t want to overlook as you prepare for this massive change.

Are you prepared to prevent financial burden under PDGM? To ensure success, agencies must take actionable steps now to fully understand exactly how the new Patient-Driven Groupings Model will impact coding scenarios and how these updates will affect revenue cycle.

Complimentary Networking Event for Post-Acute Leaders

Our upcoming Post-Acute Forum takes place November 18 & 19, 2019 in Phoenix, AZ. This complimentary event is specifically designed for decision-makers at skilled nursing facilities and home health agencies.